Endoscopic Endonasal Reconstruction of Skull Base: Repair Protocol

Dehdashti, Amir R.; Stofko, Douglas L.; Okun, Jessica; Obourn, Chelsea; Kennedy, Thomas L.

doi:10.1055/s-0035-1568871

Cited by 15 publications

(13 citation statements)

References 38 publications

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“…In our study, we found that patients who did not exhibit intraoperative CSF leak did not develop a postoperative leak also. This is in contrast to a significant 2% of patients undergoing type II repair developing postoperative leak in a study conducted by Dehdashti et al [6]. One important difference in the method of type II repair between the two studies is the additional use of a nasoseptal flap in our study.…”

Section: Csf Leak Repair and Postoperative Csf Leakcontrasting

confidence: 81%

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Umamaheswaran

Krishnaswamy

Krishnamurthy

et al. 2018

Indian J Otolaryngol Head Neck Surg

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Skull base defects following endonasal surgery for pituitary macroadenoma need to be addressed during the surgery to prevent serious postoperative complications like cerebrospinal fluid (CSF) leak. The objective of this study is to assess the incidence of CSF leak following pituitary surgery and the methods of effective skull base repair. This is a retrospective observational study conducted in a tertiary care hospital after obtaining due clearance from the Institutional ethics committee. The charts of patients who underwent endonasal pituitary surgery between 2013 and 2018 were studied and details noted. Patients undergoing revision surgery or with history of preoperative radiotherapy were excluded from the study. 52 patients were included in the study. Based on the type of CSF leak, the patients were grouped into four. 19 patients (36.5%) had an intraoperative CSF leak. 3 patients developed a postoperative CSF leak. Based on the histopathology, 4 patients had ACTH secreting tumor. 8 patients had growth hormone secreting tumor, 22 had gonadotropin secreting tumor, 9 patients had a non-functioning tumour and 9 patients had prolactinoma. The type of skull base repair performed in these patients were grouped into 4.18 patients underwent type I repair, 21 patients underwent type II repair, 8 patients underwent type III repair and 5 patients underwent type IV repair. We have observed that the pedicled nasoseptal flap is particularly advantageous over other repair techniques, especially in low pressure leaks. The strategy for skull base repair should be tailored to suit each patient to minimise the occurrence of morbidity and the duration of hospital stay.

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Section: Csf Leak Repair and Postoperative Csf Leakcontrasting

confidence: 81%

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Umamaheswaran

Krishnaswamy

Krishnamurthy

et al. 2018

Indian J Otolaryngol Head Neck Surg

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“…22,23 Thus far, skull base surgeons have been unable to consistently achieve these goals, which is reflected on the myriad of materials and techniques used by different groups, and the fact that most postoperative complications in endoscopic skull base surgery derive from failure of skull base reconstruction. [1][2][3][4][5][6] Platelet concentrates have been used for decades to promote healing in different tissues, 9,11 with L-PRF being the latest of those products to be described. 24 Yielded by natural polymerization of circulating fibrin, the resulting mesh is similar to that formed during normal hemostasis, 12,25 trapping circulating growth factors and cytokines, 8,12 and containing >80% of platelets and >50% of leukocytes of the original blood sample embedded into it.…”

Section: Discussionmentioning

confidence: 99%

Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery

et al. 2022

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BACKGROUND: Postoperative cerebrospinal fluid (CSF) leak is one of the most common complications after endoscopic endonasal approach to the skull base. OBJECTIVE: To analyze the effect of leukocyte-rich and platelet-rich fibrin (L-PRF) as part of a standardized endonasal skull base repair protocol on postoperative infection and CSF leak rate. METHODS: One hundred three patients who underwent an endoscopic endonasal approach and were reconstructed using a standard technique (Group A) were compared with 139 patients using the same protocol with the addition of L-PRF (Group B). Postoperative intracranial infection and CSF leak at 6 months were analyzed. RESULTS: In patients with intraoperative CSF leak, postoperative leak occurred in 10.8% in Group A and 2.6% in Group B (P .024), and in patients with intraoperative high-flow leaks, the incidences were 11.7% and 3.1%, respectively (P .048). L-PRF reduced postoperative CSF leak by 76% in cases with intraoperative CSF leak (relative risk 0.24, 95% CI 0.06-0.87) and by 73% of patients with high-flow leak (relative risk 0.27, 95% CI 0.07-0.99). In patients undergoing surgery for diagnoses other than adenomas, there were no cases of postoperative leak in Group B, whereas in Group A occurred in 13.4% of those with intraoperative leaks (P .047) and 15.8% with high-flow intraoperative leaks (P .033). No significant differences were found in patients with pituitary adenoma. Meningitis occurred in 0.97% in Group A vs 2.16% in Group B (P .639), without differences between subgroups. CONCLUSION: L-PRF reduced the rate of postoperative CSF leaks in patients with intraoperative leaks, without differences on postoperative meningitis.

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“…Grafts are most often held in place against the skull base with cellulose strips, tissue glues, or gelfoam, though the use of dural sealant with NSFs is not necessary and may in fact be detrimental. 7,[33][34][35][36] For cases involving vascular pedicled flaps or tenuous repairs, additional reinforcement may be provided with a nasal tampon, bioresorbable packing (eg, NasoPore), or balloon catheter, which may be removed later. 30,34 4 | INTRANASAL VASCULAR PEDICLED…”

Section: Multilayer Closure Foundation Terminology and Principlesmentioning

confidence: 99%

Vascular pedicled flaps for skull base defect reconstruction

Gutierrez

Bennion

Walsh

et al. 2020

Laryngoscope Investig Oto

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Objective: Techniques for reconstruction of skull base defects have advanced greatly since the introduction of the vascular pedicled nasoseptal flap in 2006. The objective of this review is to assess the current state of the field by examining both intranasal and extranasal techniques of vascular pedicled skull base defect repair, their indications and success rates, and novel techniques that are currently under investigation. Methods: A review of the literature describing the use of vascular pedicled flaps in skull base defect reconstruction was conducted using PubMed and Google Scholar. Results: The nasoseptal flap remains the most widely used vascular pedicled flap for endoscopic repair of skull base defects. Its ease of harvest, wide arch of rotation, and high success rates make it a popular choice among surgeons. Several variations including a "rescue" nasopseptal flap have been developed. Other less commonly used pedicled intranasal flaps include the middle turbinate flap and the posterior pedicled inferior turbinate flap. Additionally, several novel vascular pedicled flaps have been developed and tested in small cohorts of patients. Extranasal flaps such as the pericranial flap and the temporoparietal fascia flap are used less frequently than intranasal flaps. However, they remain valuable options for reconstruction in certain situations. Conclusion: Advancements continue to be made in the field of skull base defect reconstruction using vascular pedicled flaps. Though the nasoseptal flap remains the most widely utilized option, additional intranasal techniques continue to be developed and tested to optimize surgical outcomes and patient care.

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Endoscopic Endonasal Reconstruction of Skull Base: Repair Protocol

Cited by 15 publications

References 38 publications

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Outcomes of Surgical Repair of Skull Base Defects Following Endonasal Pituitary Surgery: A Retrospective Observational Study

Leukocyte-Rich and Platelet-Rich Fibrin for Skull Base Reconstruction After Endoscopic Endonasal Skull Base Surgery

Vascular pedicled flaps for skull base defect reconstruction

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